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Ambulatory Patient No Show, Late Cancellation and Late Arrival (3.3.3)

Ambulatory Patient No Show, Late Cancellation and Late Arrival (3.3.3) - Policies, Clinical, UW Health Clinical, Medical Records and Communication, Communication

3.3.3


UW HEALTH CLINICAL POLICY 1
Policy Title: Ambulatory Patient No Show, Late Cancellation and Late Arrival
Policy Number: 3.3.3
Category: UW Health
Type: Ambulatory
Effective Date: October 19, 2015

I. PURPOSE

To ensure clinical continuity of care for patients w ho late arrive, late cancel or No Show for appointments. To
provide direction regarding timely contact, documentation and follow -up as w ell as provide resources to
support the clinical practices w ith these issues.

II. DEFINITIONS

A. Late Cancellation: An adult or pediatric patient w ho cancels the appointment less than 24 hours prior to the
scheduled appointment time. Note: If the clinic/area is notif ied at any time in the 24 hours prior to the
appointment start time, the appointment should be considered a late cancellation and the
‘cancel/reschedule’ function should be used. The appointment w ould not be considered a No Show .
B. Late Arrival: An adult or pediatric patient w ho contacts the clinic/arrives after their scheduled appointment
time w ithin the same day of the appointment. Note: In this scenario, use the ‘cancel/reschedule’ function w ith
appropriate late arrival reason.
C. No Show: An adult or pediatric patient w ho does not arrive for a scheduled clinic/area appointment and
does not notify the clinic/area by end of business day.

III. POLICY ELEMENTS

The clinic/area staff and providers w ill utilize the follow ing process w hen a UW Health patient late cancels,
late arrives or No Show s.

UW Health providers and staff w ill utilize a patient and family centered approach to resolve scheduling
issues to meet patients’ medical needs and promote continuity of care. Providers w ill make every effort to
accommodate late arrivals, communicate w ith patients w ho No Show , and w ork w ith appropriate team
members to break dow n barriers our patients experience to help them successfully engage as partners in
their care. Special consideration w ill be made for children and non-decisional adults.

This policy shall be followed before any patient can be terminated from any clinic/area. There w ill be
no clinic/area-specific No Show, late cancellation, and late arrival processes and policies.

IV. PROCEDURE

A. Late Cancellations
i. Procedure for Late Cancellations (see scripts and resources in Appendix A)
a. The staff member notif ied of the cancellation w ill notify the provider or appropriate
clinic/area staff w ho w ill determine needed follow -up w ith the patient. Minimally, clinical
triage of the situation w ill occur. The follow -up could include appointment reschedule or
direct the patient to the most appropriate level of care as needed based on medical
necessity.
b. The staff member scheduling and/or arranging the follow -up w ill ask the patient if they
anticipate any issues in keeping that appointment (i.e., “Do you anticipate any issues in
making it to that appointment such as transportation, etc.?”) and assess, address social
service needs and document intervention. If barriers are more complex, refer to Patient
Resources/Coordinated Care staff/Clinic Social Worker.
c. Scheduling/Reception staff w ill change the status of the appointment per applicable
Appointment Cancellation Policy (refer to UWHC Appointment Change/Cancellation policy
or UWMF Appointment Cancellation policy).
d. The staff member w ill implement the off ice practices to f ill the open appointment slot, i.e.,
utilize w ait list (suggestions in Appendix A).
ii. Repeated Late Cancellations (see scripts and resources in Appendix A)
a. Assess if the patient has any barriers (i.e., transportation, child care issues, etc.) that
prevent him/her from keeping appointments. Address barriers and document intervention.



UW HEALTH CLINICAL POLICY 2
Policy Title: Ambulatory Patient No Show , Late Cancellation and Late Arrival
Policy Number: 3.3.3

If barriers are more complex, refer patient to Patient Resources/Coordinated Care/Clinic
Social Worker for assistance.
b. The Repeated Late Cancel/Late Arrival Letter (75668) may be sent to the patient by the
care team after assisting w ith the situation and ensuring all care needs are met.
c. Refer to Patient Resources Department if the patient has repeated late cancellations w ith
no response by patient to clinic/area intervention.
B. Late Arrival (see scripts and resources in Appendix A)
i. Procedure for Late Arrival - UW Health is committed to seeing patients on time. If patients
come late, we make every effort to work them into the day’s schedule . (Refer to ambulatory
service standards)
a. The scheduler/reception staff w ill inform the patient that their appointment time w as XXXX
time and empathize w ith the patient situation that caused them to be late. The
scheduler/reception staff w ill gather information regarding reason patient w as late and
offer assistance as needed including offering a same day appointment if available (see
scripting in Appendix A).
b. The scheduler/reception staff w ill notify clinical staff and/or provider that the patient has
arrived and determine options for the patient to be seen by the scheduled provider or a
member of the care team w ithin the day. The patient’s medical needs and reason for late
arrival w ill be considered as plans are made (i.e., patient arrived late due to our ow n
system failures).
c. Notify clinic manager if the patient w as not accommodated by the scheduled provider or a
member of the care team w ithin the day. Trends identif ied by the manager w ill be
discussed w ith the physician leader/dyad partner.
d. See Health Link guidelines for instructions regarding appointment time documentation as
needed.
ii. Repeated Late Arrivals (see scripts and resources in Appendix A)
a. Assess if the patient has any barriers (i.e., transportation, child care issues, etc .) that
prevent him/her from keeping appointments. Address barriers and document intervention.
If barriers are more complex, refer patient to Patient Resources/Coordinated Care/Clinic
Social Worker for assistance.
b. Send the Repeated Late Cancel/Late Arrival Letter (75668) or speak w ith patient to set
expectations and document the conversation.
c. Refer to Patient Resources Department if the patient has repeated late arrivals w ith no
patient response to clinic/area intervention.
C. No Shows
i. Procedure for Each Unexcused No Show (see scripts and resources in Appendix A)
a. Assess if the patient has any barriers (i.e., transportation, child care issues, etc.) that
prevent him/her from keeping appointments. Address barriers and document intervention.
If barriers are more complex, refer patient to Patient Resources/Coordinated Care/Clinic
Social Worker for assistance.
b. Scheduling/Reception staff, at the end of the session, w ill change the status of the
appointment from scheduled to No Show per Health Link guidelines. In the event that a
patient has been marked as a No Show and then arrives to be seen at the clinic/area and
it is decided that the provider w ill see the patient, update the patient’s appointment desk
per the Health Link guidelines.
c. The patient’s medical record w ill be review ed by clinical staff to determine follow -up
needed. Contact w ill be made w ith patients by telephone or by letter as deemed
appropriate based on medical need. Circumstances of “No Show ” w ill be taken into
account (i.e., did the patient No Show because s/he w as in the hospital?).
Ancillary/procedure areas w ill determine if the PCP/referring provider should be made
aw are of No Show s to their area.
d. Document calls made or other attempts to contact patient in an encounter. If no response
from patient, send the appropriate No Show letter in Health Link. Letters should be sent in
appropriate progression. There is a group class-specif ic letter (14916) and letters are
available in Spanish and Hmong.
1. Step #1: Send No Show Letter #1 Adult (10282) or No Show Letter #1
Pediatric (14904), after f irst appointment has been missed and/or no previous
letter has been sent.



UW HEALTH CLINICAL POLICY 3
Policy Title: Ambulatory Patient No Show , Late Cancellation and Late Arrival
Policy Number: 3.3.3

2. Step #2: Send No Show Letter #2 Adult (10283) or No Show Letter #2
Pediatric (32684) if patient has received No Show Letter #1 and the patient No
Show s again.
3. Step #3: Send No Show Letter #3 Adult (10284) or No Show Letter #3
Pediatric (32686), if patient has received No Show Letter # 2 and the patient No
Show s again.
For Pediatric patients, contact Patient Resources prior to w arning the pediatric
patient that s/he w ill be terminated for additional No Show s.

Note: If a patient does not No Show for an entire year, the clinic/area should
consider using No Show letter #1 or #2 vs. providing f inal w arning or No Further
Service (NFS) of the patient. Patient Resources can be consulted on such
situations.
ii. Procedure for repeat No Shows by same patient (see scripts and resources in Appendix A)
a. Assess if the patient has any barriers (i.e., transportation, child care issues, etc.) that
prevent him/her from keeping appointments. Address barriers and document intervention.
If needs are more complex (i.e. homeless, multiple needs), refer patient to Patient
Resources/Coordinated Care/Clinic Social Worker for assistance.
b. Send appropriate No Show letter to the patient.
c. Refer to Patient Resources Department if the patient has No Show ed after receiving the
third No Show letter and the provider w ould like to request No Further Service.

V. COORDINATION

Author(s): Director of Patient Resources
Senior Management Sponsor: Chief Medical Officer
Review ers: LACLANS Workgroup
Approval committees: UWISCO, Ambulatory Operations, Access Subgroup; UW Health Clinical Policy
Committee; Medical Board
UW Health Clinical Policy Committee Approval: September 21, 2015

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

ξ Patient Did Not Show or Left Without Being Seen: End of Day guidelines
ξ Schedule Same Day Appointment and Cancel/Reschedule Appointment
ξ UWHC policy #3.04, Appointment Change/Cancellation- Ambulatory Services
ξ UWMF policy, Appointment Cancellation
ξ Ambulatory service standards
ξ Routing Primary Care Telephone Calls – Pediatric/Adult – Ambulatory – Clinical Practice Guideline
ξ Routing Specialty Care Telephone Calls – Pediatric/Adult – Ambulatory – Clinical Practice Guideline
ξ UW Health Clinical Policy #1.2.6, No Further Service
ξ No Show Letter Template – Adult
ξ No Show Letter Template – Pediatric



UW HEALTH CLINICAL POLICY 4
Policy Title: Ambulatory Patient No Show , Late Cancellation and Late Arrival
Policy Number: 3.3.3

ξ Appendix A – Tips for Managing No Show , Late Cancellations, Late Arrival Patients

VIII. REVIEW DETAILS
Version: Revision
Next Revision Due: February 19, 2017
Formerly Know n as: UWMF policy, Patient No Show Guideline; UWHC – Department Specif ic policy #3.02,
No Show – Ambulatory Adult